Abstract Details

Title EEG as a Predictive Tool for Seizures and Survival Outcomes Related to CAR T-cell Therapy

Topic Epilepsy/Clinical Neurophysiology (EEG)

Presentation(s) P3 - Poster Session 3 (11:45 AM-12:45 PM)

Poster/Presentation
Number 9-002

Objective To analyze EEG patterns and outcomes in patients undergoing CAR T-cell therapy for hematologic malignancies.

Background Chimeric antigen receptor T-cell (CAR T-cell) therapy poses a risk of immune effector cell-associated neurotoxicity syndrome (ICANS), which may include encephalopathy and seizures and can lead to worsened outcomes. EEG is often required, but its utility in prognosis regarding seizure risk and outcomes following treatment is not well described.

Design/Methods This is a retrospective study including patients receiving CAR T-cell therapy across all 3 Mayo sites between October 2019 and July 2024 to assess EEG features and associated outcomes and seizure risk.

Results

A total of 206 patients were included (median follow-up 14 months, IQR 5-20), 104 underwent baseline EEG before treatment and 82 underwent EEG (37 continuous EEG) in the acute phase of ICANS. Baseline EEG demonstrated epileptiform discharges (n=1/104), and mild (n=16/104) or moderate (n=4/104) encephalopathy with concomitant regional slowing (n=1/104). EEG during acute phase of ICANS demonstrated encephalopathy (78/82, 95.1%), sporadic epileptiform discharges (6/82, 7.3%), and rhythmic and periodic patterns (RPPs) manifest by generalized periodic discharges (GPDs) with (n=19/82) and without (n=6/82) triphasic morphology, lateralized periodic discharges (n=2/82), and lateralized (n=5/82), generalized (n=5/82), or frontal intermittent (n=5/82) rhythmic delta activity. Acute symptomatic seizures (ASyS) occurred in 9 patients, 2 being subclinical requiring EEG for diagnosis. Characteristics of baseline EEG and EEG during ICANS were not associated with seizures. Encephalopathy on baseline EEG was predictive of a higher likelihood of death at last follow up (p=0.029) and shorter survival (p=0.002) following CAR T-cell therapy.

Conclusions EEG performed during ICANS from CAR T-cell therapy demonstrates low rates of seizures, with the most frequent finding being encephalopathy. RPPs are also seen, with GPDs with triphasic morphology being most common. The presence of encephalopathy on baseline EEG predicts worse outcome following CAR T-cell therapy.

Authors/Disclosures
Guido Chiriboga PRESENTER	Mr. Chiriboga has nothing to disclose.
Thomas Pecha, MD	Mr. Pecha has nothing to disclose.
Andy Shar	Mr. Shar has nothing to disclose.
Toni Betiku	Miss Betiku has nothing to disclose.
Anteneh M. Feyissa, MD, MSc, FAAN (Mayo Clinic)	Dr. Feyissa has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Neurelis.
Cornelia Drees, MD (Mayo Clinic Arizona)	Dr. Drees has nothing to disclose.
Wendy Sherman, MD (Mayo Clinic)	Dr. Sherman has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Focused ultrasound foundation . Dr. Sherman has received personal compensation in the range of $500-$4,999 for serving as a Advisory Board Member with Kiyatec.
Hong Qin, MD, PhD	Dr. Qin has received personal compensation for serving as an employee of Mayo Clinic Florida. The institution of Dr. Qin has received research support from NIH R01 grant. Dr. Qin has received intellectual property interests from a discovery or technology relating to health care.
Jeffrey W. Britton, MD, FAAN (Mayo Graduate School of Medicine)	Dr. Britton has received personal compensation in the range of $0-$499 for serving as a Online course with American Clinical Neurophysiology Society.
Alfredo Quinones-Hinojosa	Alfredo Quinones-Hinojosa has nothing to disclose.
William O. Tatum IV, DO, FAAN (Mayo Clinic)	Dr. Tatum has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Bioserenity. Dr. Tatum has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Natus. Dr. Tatum has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Neurelis. Dr. Tatum has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Elsevier. Dr. Tatum has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Defense Law Firm on behalf of a patient with epilepsy with funds donated to the Epilepsy Foundation of America. The institution of Dr. Tatum has received research support from Esai. The institution of Dr. Tatum has received research support from Mayo Clinic. The institution of Dr. Tatum has received research support from Liva Nova. The institution of Dr. Tatum has received research support from Engage Pharmaceuticals. The institution of Dr. Tatum has received research support from Xenon. Dr. Tatum has received intellectual property interests from a discovery or technology relating to health care. Dr. Tatum has received publishing royalties from a publication relating to health care. Dr. Tatum has received publishing royalties from a publication relating to health care. Dr. Tatum has received publishing royalties from a publication relating to health care. Dr. Tatum has a non-compensated relationship as a AAN Section Chair of Clinical Neurophysiology with AAN that is relevant to AAN interests or activities.
Brin Freund, MD	Dr. Freund has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for UCB. Dr. Freund has received research support from Mayo Clinic.

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